{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:09:52Z","timestamp":1789780192031,"version":"4.0.1"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECT<\/jats:title>\n                    <jats:p>This study was undertaken to analyze the predisposing factors, clinical presentation, therapeutic management, and clinical recovery in patients with pituitary apoplexy, with an emphasis on the long-term visual, endocrine, and functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors performed a retrospective analysis of consecutive cases involving patients treated at Mayo Clinic between 1992 and 2013. Patients were included in the study only if they had 1) abrupt onset of severe headache or visual disturbance in the presence of a pituitary adenoma and 2) radiological or surgical confirmation of a pituitary mass. The primary endpoints of analysis were the visual (ocular motility, visual fields, and visual acuity), endocrine, and functional outcomes (using the modified Rankin Scale).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Eighty-seven patients were identified (57 males and 30 females, mean age 50.9 years, range 15\u201391 years). Twenty-two patients (25.3%) had a known pituitary adenoma. Hypertension was the most common associated factor (39%). Headache was the most frequent presenting symptom (89.7%), followed by visual abnormalities (47.1%). Cranial nerve palsies were present in 39% and visual field defects in 34.1%. MRI detected hemorrhage in 89% patients, as compared with 42% detected by CT scan. Sixty-one patients (70.1%) underwent surgery during acute hospitalization (median time from apoplexy 5 days, IQR 3\u201310 days), 8 (9.2%) had delayed surgery, and 18 (20.7%) were treated conservatively. Histopathological examination revealed adenoma with pure necrosis in 18 (30%), pure hemorrhage in 4 (6.7%), and both in 6 (10%) patients. Four patients died during hospitalization. The average duration of follow-up was 44.2 \u00b1 43.8 months. All survivors were independent and had complete resolution or substantial improvement in eye movements and visual fields at the last follow-up. Many patients needed long-term hormonal replacement with levothyroxine (62.7%) and cortisol (60%). Daily desmopressin was needed in 23% of all surgical patients at 3 months (versus none of the medically treated) and this requirement decreased slightly over time. Regrowth of pituitary adenoma was seen in 7 patients (8.6%). There were no statistically significant differences in any of the outcome measures across the treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The outcome of most patients with pituitary apoplexy is excellent. Selected patients can be managed conservatively, and patients with severe neuro-ophthalmological deficits treated with early surgery can achieve an excellent recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2014.10.jns141204","type":"journal-article","created":{"date-parts":[[2015,4,10]],"date-time":"2015-04-10T20:27:01Z","timestamp":1428697621000},"page":"1450-1457","source":"Crossref","is-referenced-by-count":99,"title":["Management and outcomes of pituitary apoplexy"],"prefix":"10.3171","volume":"122","author":[{"given":"Tarun D.","family":"Singh","sequence":"first","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navid","family":"Valizadeh","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fredric B.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L. D.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Neurosurgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Erickson","sequence":"additional","affiliation":[{"name":"Endocrinology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro A.","family":"Rabinstein","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns141204","series-title":"BMJ","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1136\/bmj.329.7459.218","article-title":"Acute visual loss and pituitary apoplexy after surgery","volume":"329","author":"Abbott","year":"2004"},{"key":"b2-jns141204","series-title":"Ann Thorac Surg","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/S0003-4975(01)02850-8","article-title":"Ptosis postcardiac surgery: a case of pituitary apoplexy","volume":"73","author":"Alzetani","year":"2002"},{"key":"b3-jns141204","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1210\/jcem-71-2-323","article-title":"Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy","volume":"71","author":"Arafah","year":"1990"},{"key":"b4-jns141204","series-title":"Am J Med","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/S0002-9343(89)80494-2","article-title":"Apoplexy of a pituitary adenoma after dynamic testing with gonadotropin-releasing hormone","volume":"87","author":"Arafah","year":"1989"},{"key":"b5-jns141204","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1111\/j.1365-2265.2004.02162.x","article-title":"Acute management of pituitary apoplexy\u2014surgery or conservative management?","volume":"61","author":"Ayuk","year":"2004"},{"key":"b6-jns141204","series-title":"Philadelphia Med J","first-page":"789","article-title":"Pathological report of a case of acromegaly with especial reference to the lesion in the hypophysis cerebri and in the thyroid gland; and a case of hemorrhage into the pituitary","volume":"1","author":"Bailey","year":"1898"},{"key":"b7-jns141204","series-title":"J Obstet Gynaecol","doi-asserted-by":"publisher","first-page":"662","DOI":"10.3109\/01443615.2011.590911","article-title":"A case of pituitary apoplexy masquerading as hyperemesis gravidarum","volume":"31","author":"Bamfo","year":"2011"},{"key":"b8-jns141204","series-title":"Neurosurgery","first-page":"602","article-title":"A retrospective analysis of pituitary apoplexy","volume":"33","author":"Bills","year":"1993"},{"key":"b9-jns141204","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1136\/jnnp.71.4.542","article-title":"Precipitating factors in pituitary apoplexy","volume":"71","author":"Biousse","year":"2001"},{"key":"b10-jns141204","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1007\/BF02112028","article-title":"Pituitary apoplexy: endocrine, surgical and oncological emergency. 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